Lumbar Spine Movement Control Flashcards
Lumbar stabilization intervention CPR criteria
- Age <40
- Avg. straight leg raise >91º
- Positive prone instability test
- Aberrant movement present (stability catch, painful arc, thigh climbing, reversal of limbo-pelvic rhythm
- NO sx distal to buttocks or signs of nerve root compression
Lumbar spine stabilization patient looks like
- Younger
- Flexible
- Possibly athlete that trains primarily one way
Treatment grades for spondylolisthesis & Scotty Dog Sign
- Grade I: usually not symptomatic
- Grade II: education to avoid extension & begin spinal stabilization; may use casting to reduce anterior shear forces & allow healing
- Grade IIII: conservative treatment may be attempted; surgery
- Grade IV: surgery due to neurological involvement
What muscles have delayed activation in LBP patients
- Transverse abdominus (TRA) & multifidus
Characteristics of the global dynamic stabilizers of the spine
- Superficial
- Cross multiple segments
- Motion & COM
- Compressive load when active
List the global dynamic stabilizers of the spine
- Rectus abdominus
- External/internal oblique
- Quadratus lumborum (lateral)
- Erector spinae
- Illiopsoas
Characteristics of the deep segmental dynamic stabilizers of the spine
- Deep
- Cross & attach to each vertebral segment
- Endurance: slow twitch type 1
List the deep segmental dynamic stabilizers of the spine
- Transverse abdominus
- Multifidus
- Quadratus lumborum (deep)
- Deep rotators
Describe the transverse abdominus
- Deepest abdominal muscle
- Attaches posterior to vertebra via thoracolumbar facia
- Develops tension to support
- Active in both isometric flexion & extension
- Responds to anticipatory & rapid UE/LE actions
- Links with the perineum, pelvic floor, & multifidi
Describe the multifidus
- Control movements of segments & increase stiffness
- Encased in lumbodorsal fascia
- Moth eaten appearance & increased fatty infiltration in chronic LBP patient
Hallmarks oof movement system impairment syndromes
- All people develop movement patterns as a strategy to perform any activity
- Pain from repetitive movement patterns that result in movement impairments: body takes path of least resistance; hyper mobility = tissues moving out of optimal range
- Improve by correction of movement impairment: treat cause not Sx, balance & precise movements, and train correct pattern & not isolated strengthening
Define positional versus movement fault
- Positional: refers to a body structure that has become static
- Movement: refers to a learned movement pattern
How to exam local mobility in sitting and standing
- Slump test
- Thoracic rotation
- Observe curvature, LEs alignment
- Pelvic static asymmetry
- Latissimus dorsi tightness (full shoulder flexion)
How to exam global stability in sitting and standing
- Active knee extension
- Sit to stand test
- Spine ROM
- Thoracolumbar dissociation
- Lumbopelvic/hip dissociation
- Trendelenburg test
- Step up-down test
- Squat
Causes of excessive lumbar extension
- Mobility (Latissimus)
- Stability (MC = movement control) lacks abdominal stability (allows lumbar extension too easily)
Causes of excessive lumbar extension with bent knee fall out
- Mobility: limited hip
- Hip dominated motion patten (movement control)
- Locks lumbopelvic stabilization (MC)
Causes of excessive lumbar potation with hip extension
- Lacks lumbar stabilization
- Glute Maximus activates too quick
- Lacks hip extension
Causes of excessive flexion
- Mobility: lacks hip motion
- Stability: lumbar flexion is facilitated
Movement control progressions
- Start where the impairment is
- Recognize hyperactivity & normalize breathing exercise, manual therapy, & verbal/tactile cues to relax
- Once hyperactivity decreased then begin co-contraction
Describe the activation phase
- Goal: activate hypoactive muscles
- Single plane
- Test = beginning exercise
- Need verbal & tactile feedback
- Consider mobility limitations
- Isometric > NWB/gravity minimized > gravity/resisted
What are the different ways to teach transverse abdominus activation
- Drawling in maneuver
- Abdominal bracing
- Posterior pelvic tilt
Describe the acquisition phase
- Goal: train dissociation or coordination
- Test = beginning exercise
- Need verbal & tactile feedback
- If mobility still lacking will interfere with acquisition
Describe the assimilation phase
- Goal: assimilate skills to functional activities
- Look at specific tasks (ADLs) & adjust exercises: lifting/lowering, pushing/pulling, reaching/handing, trunk twisting, reciprocating
- Transfer principle (motor control): train & environment should be similar to task
